Assessment of risk factors associated with multidrug-resistant organism infections among patients admitted in a tertiary hospital - a retrospective study

Alsehemi, Alaa F.; Alharbi, Emad A.; Al-amash, Buthainah B.; Alrais, Alaa; Elbadawy, Hossein M.; Alahmadi, Yaser M.

doi:10.1016/j.jsps.2023.03.019

Cited by 6 publications

(4 citation statements)

References 27 publications

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“…On the other hand, MDR Pseudomonas aeruginosa infection was independently association with sex, age, and comorbidities, and correlated with ventilation history and neutropenia (51). On the other hand, cotrimoxazole, amikacin, or imipenem except cefazolin; admission to ICU and prior use of acid-suppressive medication were associated with infection with MDR organisms (52). These factors can be targeted by strategies to control AMR and those to improve patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Resistance related Mortality, Length of Hospital Stay, and Disability-Adjusted Life Years at select Tertiary Hospitals in Uganda:A retrospective study

Mayito,

Dhikusooka,

Kibombo

et al. 2024

Preprint

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Background Antimicrobial Resistance (AMR) is a major global health threat but its burden has not been extensively described in Uganda. We aimed to investigate the antibiotic resistance related mortality, length of hospital stays (LOS) and Disability Adjusted Life Years (DALYs). Methods This was a retrospective study of clinical records of patients with infectious syndromes admitted at Arua, Jinja and Mbale regional referral hospitals between October 2022 and September 2023. Data was abstracted from clinical records and analyzed to derive the mortality, LOS, DALYs, and factors associated with AMR and mortality using the modified Poisson regression model. Results: Of the 291 participants included in the analysis, 56.6% were males, 10% were living with HIV, and their median age was 35 years (IQR: 21-56). The most common infectious syndromes were sepsis (43.6%) and diarrhea (9.6%). The prevalence of antibiotic-resistant infections (ARI) was 29.6%, while that for multi-drug resistant infections (MDRI) was 17.9%. Patients at Jinja and Mbale RRHs exhibited a 2.42 and 2.65 higher risk of ARI respectively compared to those at Arua RRH. Overall, mortality due to an infectious syndrome was 44.7%, of which 34.9% was due to ARI while 30.8% of the ARI related mortality was due to MDR infections. Most deaths were due to sepsis (42.3%), followed by pneumonia (15.4%) and meningitis (6.2%). Participants with comorbidities had higher risk of mortality due to ARI (45% vs. 31% for those without comorbidities). Among Gram-negative bacteria, Escherichia coli and Klebsiella spp contributed most to mortality, while among Gram-positives, Staphylococcus aureus and Enterobacter spp contributed equally. Patients with ARI’s LOS was 1.2 times higher than that for those without ARI while a longer LOS was associated with a 21% higher ARI risk but a 24% decline in risk of death. ARI was associated with higher DALYs, 235.4, compared to 147.0 for non-ARI. Conclusion The study revealed a high burden of AMR in Uganda, including a high prevalence of MDR and associated mortality, particularly among patients with comorbidities. This indicates an urgent need for stewardship and infection prevention strategies to control the AMR burden.

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Section: Discussionmentioning

confidence: 99%

Antibiotic Resistance related Mortality, Length of Hospital Stay, and Disability-Adjusted Life Years at select Tertiary Hospitals in Uganda:A retrospective study

Mayito,

Dhikusooka,

Kibombo

et al. 2024

Preprint

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“…Additionally, these are more likely to access antibiotics through self-medication, which increases the risk of AMR. Age has previously not been associated with MDR SSTI elsewhere [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence, resistance profiles and factors associated with skin and soft-tissue infections at Jinja regional referral hospital: A retrospective study

Lwigale,

Kibombo,

Kasango

et al. 2024

PLOS Glob Public Health

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Skin and soft-tissue infections (SSTI) are common cases of hospital-acquired infections with aetiological agents exhibiting antimicrobial resistance (AMR). This is a global public health predicament responsible for a high burden of infectious diseases and threatens the achievement of Sustainable Development Goals (SDGs), especially in Low- and Middle-Income countries (LMICs). This study determined the prevalence of SSTI, proportion of laboratory-investigated cases, AMR-profiles, and factors associated with SSTI and multi-drug resistance (MDR). This was based on records of patients suspected of SSTI for the period of 2019–2021 at Jinja Regional Referral Hospital. The analysis involved 268 randomly selected patient reports using WHONET 2022 and Stata 17 at the 95% confidence level. The prevalence of SSTI was 66.4%. Cases that involved laboratory testing were 14.1%. Staphylococcus aureus (n = 51) was the most isolated organism. MDR pathogens explained 47% of infections. Methicillin-resistant Staphylococcus aureus (MRSA) was up to 44%. In addition, 61% of Gram-negatives had the potential to produce extended-spectrum beta-lactamases (ESBL), while 27% were non-susceptible to carbapenems. Ward of admission was significantly associated with infection (aPR = 1.78, 95% CI: 1.00–3.18, p-value = 0.04). Age category (19–35) was an independent predictor for MDR infections (aPR = 2.30, 95%CI:1.02–5.23, p-value = 0.04). The prevalence of SSTI is high with MDR pathogens responsible for almost half of the infections. Gentamicin and ciprofloxacin can be considered for empirical management of strictly emergency SSTI cases suspected of Staphylococcus aureus. Given the high resistance observed, laboratory-based diagnosis should be increased to use the most appropriate treatment. Infection Prevention and Control (IPC) strategies should be heightened to reduce the prevalence of SSTI. Recognizing SSTI under the Global Antimicrobial resistance Surveillance System (GLASS) would lead to improved preparedness and response to AMR.

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“…Although many studies in Saudi Arabia have evaluated the MDR patterns of gram-negative pathogens, data considering the risk factors of acquisition of MDR pattern is still limited 8 , 10 – 12 . For example, in a study conducted at King Saud Medical City, a premier health centre in Saudi Arabia, Al Mayahi found that the uncontrolled use of antibiotics, prolonged stay in the intensive care unit (ICU) and frequent use of different devices are the potential risk factors in developing colistin resistance 13 .…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the risk factors that contribute to acquiring infection with MDR bacterial pathogens must be investigated. Thus, it can be hypothesized that the acquisition of infections with MDR pathogens might be correlated to patients’ sex 11 , age group 14 , hospitalization status, underlying condition and ICU admission 12 . More importantly, detecting such risk factors can facilitate the utilization of antibiotics in clinical practice and provide useful information to guide decision-making and control implementation of programs 11 .…”

Section: Introductionmentioning

confidence: 99%

Risk factors in acquiring multidrug-resistant Klebsiella pneumoniae infections in a hospital setting in Saudi Arabia

Ibrahim

2023

Sci Rep

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Over the last decades, the prevalence of multidrug-resistant (MDR) Klebsiella pneumoniae in clinical settings has increased progressively. This study determined the prevalence and risk factors associated with MDR K. pneumoniae infection among hospitalized patients in a referral hospital located in southern Saudi Arabia. A prospective cross-sectional study was conducted in King Abdullah Hospital from April 2021 to March 2022. K. pneumoniae (n = 211) bacteria were recovered from clinical samples of adult patients and examined for antibiotic susceptibility. Univariate and multivariate logistic regressions were applied to determine the factors associated with MDR K. pneumoniae infection. MDR K. pneumoniae strains was found in 66.8% (142/211) of the patients. Among MDR K. pneumoniae, the highest resistance rate was determined for ampicillin (100%), cefuroxime (97.9%), ceftriaxone (94.3%), and aztreonam (92.2%). The lowest resistance rate was determined for colistin (16.3%), and tigecycline (6.4%). Further, the patients’ gender, age group, intensive care unit (ICU) admission, invasive medical devices, and chronic illness were found to be significantly associated with MDR K. pneumoniae infection. The independent risk factors associated with MDR K. pneumoniae infection were the male gender (adjusted odds ratio [AOR] 2.107, 95% confidence interval CI 1.125‒3.945, p = 0.02), patients ≥ 65 years of age (AOR 1.905; CI 1.003‒3.616, p = 0.049), ICU admission (AOR 1.963; CI 1.033‒3.732, p = 0.04), diabetes (AOR 1.95; CI 1.02‒3.727, p = 0.043) and chronic obstructive pulmonary disease (AOR 7.172; CI 1.557‒33.032, p = 0.011). The study offered a vision of MDR K. pneumoniae infection in our setting and provided essential indications for further studies that may lead to the prevention and reduction of MDR bacteria.

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Assessment of risk factors associated with multidrug-resistant organism infections among patients admitted in a tertiary hospital - a retrospective study

Cited by 6 publications

References 27 publications

Antibiotic Resistance related Mortality, Length of Hospital Stay, and Disability-Adjusted Life Years at select Tertiary Hospitals in Uganda:A retrospective study

Antibiotic Resistance related Mortality, Length of Hospital Stay, and Disability-Adjusted Life Years at select Tertiary Hospitals in Uganda:A retrospective study

Prevalence, resistance profiles and factors associated with skin and soft-tissue infections at Jinja regional referral hospital: A retrospective study

Risk factors in acquiring multidrug-resistant Klebsiella pneumoniae infections in a hospital setting in Saudi Arabia

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